Provider Demographics
NPI:1760625651
Name:MICHIGAN AUDIOLOGY & HEARING CENTER, PLLC
Entity Type:Organization
Organization Name:MICHIGAN AUDIOLOGY & HEARING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:GERBINO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:586-716-0500
Mailing Address - Street 1:35054 23 MILE RD
Mailing Address - Street 2:BLDG. B., SUITE 104
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2019
Mailing Address - Country:US
Mailing Address - Phone:586-716-0500
Mailing Address - Fax:586-716-0789
Practice Address - Street 1:35054 23 MILE RD
Practice Address - Street 2:BLDG. B., SUITE 104
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-2019
Practice Address - Country:US
Practice Address - Phone:586-716-0500
Practice Address - Fax:586-716-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000037231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E003140OtherBLUE CROSS BLUE SHIELD OF MICHIGAN-HEARING AID DEALER
MI640E026870OtherBLUE CROSS BLUE SHIELD OF MICHIGAN-AUDIOLOGIST